Individual
MALLORY POLIVKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., R-DMT
Contact information
Practice address
101 W 2ND ST, DULUTH, MN 55802
(218) 724-3122
Mailing address
211 MORLEY PKWY, DULUTH, MN 55803-2127
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/15/2017
Last updated
08/20/2018
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